Outcomes of Surgery for Simple Total Anomalous Pulmonary Venous Drainage in Neonates
Outcomes of Surgery for Simple Total Anomalous Pulmonary Venous Drainage in Neonates
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DOI：
10.1016/j.athoracsur.2010.12.069
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发表时间：
2011-06-01
影响因子：
4.6
通讯作者：
Konstantinov, Igor E.
中科院分区：
文献类型：
--
作者：
Yong, Matthew S.;d'Udekem, Yves;Konstantinov, Igor E.
背景。新生儿完全异常肺静脉引流（TAPVD）的修复仍然是一个挑战，因为它通常与严重的梗阻有关。我们描述了一个大队列的新生儿接受TAPVD修复在单一机构。从1973年到2008年，112名患者在出生后的第一个月接受了简单的TAPVD手术。数据收集是回顾性的。术前发生肺静脉阻塞89例（79.5%）。早期死亡12例（10.7%）。搭桥时间大于65分钟（p = 0.014）和紧急手术（p = 0.005）是显著危险因素。尽管近10年来术前酸中毒（p = 0.004）和严重TAPVD阻塞（p = 0.038）的患者有所增加，但在这3个时期（1973 - 1988年、1989 - 1998年、1999 - 2008年）的住院死亡率没有变化。修复后2年内晚期死亡6例（6.25%）。20年生存率为83.4%（95%可信区间75 - 89）。晚期死亡的危险因素为手术体重2.5 kg及以下（p = 0.004）和术后肺动脉高压危象（p = 0.02）。13例（11.9%）复发性PVO患者需要再次手术。危险因素为手术体重2.5 kg及以下（p = 0.035）和术后肺动脉高压危象（p = 0.002）。随访完成率96%，幸存者（n = 90）无症状，中位年龄为11.7岁。医院死亡率在36年期间保持不变。2年以上的生存提供了很好的结果。死亡率的危险因素为术前临床状态、搭桥时间延长、持续微阻塞、手术体重过轻。降低死亡率可能需要对不能手术修复的外周PVO患者进行有效的医疗管理。（Ann Thorac surgery, 2011;91:1921-7） (C) 2011年由胸外科学会出版
Background. Repair of total anomalous pulmonary venous drainage (TAPVD) in neonates remains a challenge as it is often associated with severe obstruction. We describe a large cohort of neonates who underwent TAPVD repair at a single institution.Methods. From 1973 to 2008, 112 patients underwent simple TAPVD surgery during the first month of life. Data collection occurred retrospectively.Results. Preoperative pulmonary venous obstruction (PVO) occurred in 89 (79.5%) patients. There were 12 (10.7%) early deaths. Significant risk factors were bypass time greater than 65 minutes (p = 0.014) and emergent surgery (p = 0.005). Hospital mortality was unchanged throughout the 3 eras (1973 to 1988, 1989 to 1998, 1999 to 2008), despite an increase in patients with preoperative acidosis (p = 0.004) and severe TAPVD obstruction (p = 0.038) during the recent 10 years. There were 6 (6.25%) late deaths within 2 years of repair. Survival at 20 years was 83.4% (95% confidence interval 75 to 89). Risk factors for late death were operative weight 2.5 kg or less (p = 0.004) and postoperative pulmonary hypertensive crisis (p = 0.02). Reoperation for recurrent PVO was required in 13 patients (11.9%). Risk factors were operative weight 2.5 kg or less (p = 0.035) and postoperative pulmonary hypertensive crisis (p = 0.002). Follow-up was 96% complete and survivors (n = 90) were asymptomatic at a median age of 11.7 years.Conclusions. Hospital mortality remained unchanged over the 36-year period. Survival beyond 2 years offers excellent outcome. Risk factors for mortality were the preoperative clinical status, prolonged bypass time, persisting micro-obstruction, and low operative weight. A reduction in mortality will likely require development of effective medical management for patients who have peripheral PVO not amenable to surgical repair. (Ann Thorac Surg 2011;91:1921-7) (C) 2011 by The Society of Thoracic Surgeons